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Patient Safety and Quality in Home Health Care.


In: Hughes RG, editor.


Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 13.
Advances in Patient Safety.

Author information

Carol Hall Ellenbecker, Ph.D., R.N., professor, University of Massachusetts, Boston. E-mail:
Linda Samia, Ph.D., R.N., program manager, Healthy Choices for ME, MaineHealth’s Partnership for Healthy Aging. E-mail:
Margaret J. Cushman, Ph.D.(c), R.N., F.H.H.C., F.A.A.N., research associate, University of Massachusetts, Boston.
Kristine Alster, Ed.D., R.N., associate provost, University of Massachusetts, Boston. E-mail:


Home health care clinicians seek to provide high quality, safe care in ways that honor patient autonomy and accommodate the individual characteristics of each patient’s home and family. Falls, declining functional abilities, pressure ulcers and nonhealing wounds, and adverse events related to medication administration all have the potential to result in unplanned hospital admissions. Such hospitalizations undermine the achievement of important home health care goals: keeping patients at home and promoting optimal well-being. Nevertheless, the unique characteristics of home health care may make it difficult to use—or necessary to alter—interventions that have been shown to be effective in other settings. Therefore, research on effective practices, conducted in home health care settings, is necessary to support excellent and evidence-based care. In reviewing the extant studies, the authors of this chapter found useful evidence in all selected areas. However, the number of studies was few and many questions remain. Replications of investigations originally conducted in health care settings other than the home, and studies considering home health care-specific issues are needed to support evidence-based clinical decisions. The available evidence suggests that the work environment in which home health care nurses practice may indirectly influence patient outcomes in many areas, and that technology can be used to support positive patient outcomes. Thus, studies that link nurse-related variables to improved care safety and quality are needed, as well as studies that focus directly on patients. The demographics of an aging society will sustain the trend toward home-based care. Home health care practices grounded in careful research will sustain the patients and the clinicians who serve them. Given the focused review of evidence-based studies comprising this chapter, many informative sources of use to the practicing home health care nurse are omitted. Table 8 lists additional key resources.

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